Abstract 14722: Preoperative Left Ventricular End-diastolic volume is a Single Predictive Factor of Functional Recovery After Coronary Artery Bypass Grafting for Ischaemic Cardiomyopathy
Introduction: It has been indicated that prognostic effects of coronary artery bypass grafting (CABG) for patients having low left ventricular ejection fraction (LVEF) preoperatively depend upon the stage of the LV remodeling at the time of the surgery. Magnitude of functional recovery post-CABG in association with the prognostic effects is however not fully understood. We therefore investigated long-term outcomes post-CABG for low LVEF patients in association with postoperative LV function and the predictive factors of functional recovery post-CABG.
Methods: A consecutive series of 60 patients who had LVEF less than 40% preoperatively and underwent isolated CABG in our institution between 2002 and 2013 was enrolled in this study. Ischaemic territories were successfully grafted as assessed by early postoperative coronary angiography in all patients, who were echocardiographically followed-up for more than 30 days.
Results: Since 40 patients (67%) showed improvement in LVEF by more than 5% during 3.7±2.9 years postoperatively, the cohorts were divided into the following two groups for further analysis; ΔEF >5% group (n=40) and ΔEF ≤5% group (n=20). Although survival at 1, 5 and 10 years were not significantly different between the two groups (ΔEF >5%: 100%, 93%, and 93%; ΔEF ≤5%: 85%, 85%, and 85%, respectively), freedom from major adverse cardiac everts at 1, 5 and 10 years was significantly greater in the ΔEF >5% group (95%, 89% and 44%, respectively) than the ΔEF ≤5% group (79%, 53% and 40%, respectively), as assessed by Kaplan-Meier analysis. LV end-diastolic volume index was a single independent predictive factor for the improvement LVEF (>5%), as assessed by multivariate logistic regression analysis, while its cut-off value was set in 92 ml/m2, as assessed by the ROC curve analysis.
Conclusions: Greater than 60% of patients having LVEF ≤40% preoperatively showed a substantial improvement in LVEF after CABG, warranting prognostic effects of isolated CABG for ischemic cardiomyopathy. However, those having advanced stage of the LV remodelling preoperatively are unlikely to show functional recovery post-CABG, associated with adverse cardiac events.
Author Disclosures: S. Yajima: None. K. Toda: None. T. Nakamura: None. S. Miyagawa: None. Y. Yoshikawa: None. S. Fukushima: None. S. Saito: None. K. Domae: None. T. Ueno: None. T. Kuratani: None. Y. Sawa: None.
- © 2016 by American Heart Association, Inc.